Ask an Expert: How Do You Safely Detox from Benzos?

By Edward J. Khantzian 02/18/19

Dr. Khantzian (Harvard Medical School) explains how hospitals safely detox people from benzodiazepines like Xanax when withdrawals can potentially cause seizures and death.

Ask an Expert: How Do You Safely Detox From Benzos?

Dear Expert,

I know that withdrawal from Xanax is very dangerous, with risks of panic attacks and seizures and even death. How do hospitals detox people who are addicted to benzos such as Xanax?

Edward J. Khantzian, MD: You are correct that withdrawal from benzodiazepines can cause seizures and even death, and should only be done in a detox facility under medical supervision where dosages are precise and withdrawal symptoms can be carefully monitored. At the very least, benzodiazepine withdrawal should occur under the supervision of a physician with whom one has a close and honest rapport.

Detox may differ depending on the particular benzo used, so initially a physician will do a urine test to ensure that it is Xanax. Then, a program of supervised withdrawal will begin based on how much one has been taking and for how long—this will impact the chances of significant withdrawal symptoms. Xanax comes in 0.5, 1.0, 2.0, and 3.0 mg tablets. Most practitioners tend to prescribe the medication in the lower dose range, which is 0.5 mg. For withdrawal, we usually use a benzodiazepine with a slower onset and longer duration of action, such as oxazepam (Serax). After the physician establishes an initial tolerance amount, he or she will generally put the patient on a slow taper in which the oxazepam dose is decreased by 10% every few days until it can be discontinued entirely.

This is just an example of one protocol that an experienced physician or detox facility would use. As above, I strongly recommend that withdrawal occur in one of these scenarios. Under these conditions, withdrawal should be safe and comfortable. All the best.

Dr. Khantzian is Professor of Psychiatry, part time, Harvard Medical School in Boston, and President and Chairman, Board of Directors, Physician Health Services of the Massachusetts Medical Society in Waltham, Mass. He is in private practice and specializes in addiction psychiatry. Full Bio.

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